Out-of-Hospital Cardiac Arrest and Compression Only CPR on Scripted Television

Over 350,000 out-of-hospital cardiac arrests (OHCAs) happen annually, and administration of bystander cardiopulmonary resuscitation (CPR) can double or triple the chance of survival.¹ To reduce barriers to bystander action, the American Heart Association (AHA) has developed public awareness campaigns emphasizing Compression-Only CPR (COCPR), but the prevalence of COCPR administration remains low, particularly for Black and Latino people and females.¹ While the reasons for this are multifactorial, one consideration could be the depiction, or lack thereof, of COCPR in scripted television; a 2022 scoping review found health content on television can influence viewers’ behaviors.² Although previous research has examined the depiction of CPR in medical dramas, there has yet to be an examination of OHCA and COCPR on scripted television more broadly.

To address this, we identified potential depictions of OHCA and COCPR using IMDb’s keyword search (“defibrillator,” “resuscitation,” “cardiac arrest,” “CPR,” “mouth to mouth resuscitation,” “cardiopulmonary resuscitation”) filtered for “TV Episodes.” We excluded duplicates, non-scripted, non-American television shows, and episodes released before 2008—the year the AHA endorsed COCPR.³ Each remaining episode (n=169) was watched and double-coded by trained research assistants using a previously documented approach.⁴ This study was deemed non-human subjects research by the University of Pittsburgh Human Research Protection Office. Data from this study are available from the authors upon reasonable request.

For each OHCA, we assessed whether the character received COCPR, then derived sociodemographic variables (race, ethnicity, gender, age) for the character experiencing an OHCA and person performing COCPR from plot dialogue, contextual cues, and actor IMDB pages. We also coded adherence to correct COCPR: checking for scene safety/responsiveness, calling or asking someone to call 911, and beginning compressions.

Episodes were coded as OHCA if a typical viewer would perceive the event as cardiac arrest, regardless of medical accuracy (e.g., conflating cardiac and respiratory arrest). This approach aligned with our focus on lay public perception, as illustrated by the news story of a boy who saved a drowning victim by performing chest compressions after observing CPR on the show Stranger Things.⁵

Among the 169 episodes, 93 depicted OHCA, and 91.4% (n=85) depicted CPR. Of these, 63.5% (n=54) depicted CPR administered out-of-hospital by a layperson who would likely not be trained in BLS for Healthcare Providers. These 54 episodes potentially depicting COCPR formed the sample for the remaining descriptive analyses. Adherence to correct COCPR was found in 29.6% (n=16) of episodes. In 48.1% (n = 26) of episodes breaths were given along with compressions, and in 42.6% (n=23) the layperson checked for a pulse. None of the incorrect depictions were satirical in nature.

Primary witnesses to a perceived OHCA were friends (22.2%, n=12), partners (20.4%, n=11), or strangers/coworkers (18.5%, n=10). In 9.3% (n=5) instances the primary witness asked if others knew COCPR, resulting in another layperson performing it. In our sample, 20.4% (n=11) of OHCAs occurred at home. Sociodemographic information of the characters who received COCPR and those who performed it are described in Table 1.

Table 1.

Sociodemographic Information of Characters Receiving and Performing COCPR^*

	Person Receiving COCPR (n=54) N (%)	Person Giving COCPR (n=40)† N (%)
Race and Ethnicity ‡
White	35 (64.8%)	38 (70.3%)
Black	12 (22.2%)	9 (16.6%)
Asian	4 (7.4%)	4 (7.4%)
Native American	1 (1.9%)	0 (0%)
Native Hawaiian or Pacific Islander	1 (1.9%)	1 (1.9%)
White Hispanic§	1 (1.9%)	2 (3.7%)
Gender
Male	37 (68.5%)	35 (64.8%)
Female	17 (31.5%)	19 (35.2%)
Age Distribution
0–20	10 (18.5%)	9 (16.6%)
21–40	24 (44.4%)	35 (64.8%)
41–50	6 (11.1%)	9 (16.6%)
51–60	4 (7.4%)	1 (1.9%)
61+	10 (16.7%)	0 (0.0%)

^*COCPR: Compression-only CPR

^†In 14 instances COCPR was performed off-screen and thus sociodemographic information of the person giving COCPR could not be determined

^‡Race and ethnicity were evaluated separately, then combined following data analysis.

^§The sample did not include any Hispanic or Latino characters that identified as a race other than white.

In this study we observed inaccuracies that may mislead viewers about OHCA epidemiology. Specifically, over 50% of those receiving COCPR were under 40 years old, while the mean age of COCPR receipt in real-life is 61.8. ¹ Additionally, in real-life over 80% of OHCAs occur in homes,¹ in contrast to only 20.4% in our sample. Moreover, we found that television depictions commonly feature white and male individuals as both recipients and providers of COCPR. While this may simply reflect disparities in on-screen roles, future research could assess whether mirroring real-life disparities in COCPR receipt on screen¹ perpetuates implicit biases among viewers.

Limitations of this study include potentially missing depictions of COCPR not captured via our keyword search and using actor demographics per IMDB when this information was not apparent in the episode. Another limitation is the potential for coder bias when assessing demographics, although we aimed to minimize this by double-coding using a standardized, previously-used protocol.⁴ We also did not account for the distribution of audiences’ sociodemographic characteristics. For example, it may be that television programs featuring a Black character receiving COCPR have larger Black audiences.

Despite these limitations, our analysis of OHCA and COCPR onscreen is a promising step to examining the potential influence of these depictions on viewers. Approximately 58% of those who experienced an OHCA received COCPR, greater than the real-world likelihood (39.6%).1 This may motivate viewers to act if they witness an OHCA, but the frequent depiction of outdated practices (e.g. pulse checks) contradicts current AHA efforts to reduce barriers to action. Collaborative efforts between public health agencies and content creators could assist to achieve AHA goals, such as helping lay responders envision using CPR to help a loved one at home and developing training that highlights existing disparities in COCPR receipt.¹

Non-standard Abbreviations and Acronyms

AHA

American Health Association

CPR

Cardiopulmonary resuscitation

COCPR

Compression-only CPR

OHCA

Out-of-hospital cardiac arrest

IMDb

Internet movie database